How to Make a Medical Home Deliver

"That means many aspects of the patient's care are provided by people who are not physicians," Ziring says. "We all know that in the current economy, medicine is at best a zero-sum game, so it's not an opportunity to have physicians necessarily spend more time with patients. Instead, we can make use of everyone in a better way so the patient gets more quality time with their physician."

Jefferson has achieved Level 3 status as a patient-centered medical home—the highest designation from the National Committee for Quality Assurance, which certifies medical homes nationally—but the process takes some getting used to, by patients and providers alike.

Patients are finding they're summoned to previsit planning meetings that might involve lab visits so results are ready by the time the physician appointment takes place. Such meetings might also involve a consult with a social worker, a nurse, or nutritionist. And with an electronic medical record populated with the latest results, visits with the physician are more productive and offer fresh data for the doctor to review with the patient.

"Instead of the patient getting an appointment that's 20 minutes with one person, they might get an hour in sum total with others," Ziring says.

But do the patients like it?
"We're starting to measure that but at the moment, it's not something we keep particular track of," Ziring says. "But the physicians get the sense that there's improvement in patient compliance and satisfaction. And I should say that in practices that have been doing this longer than we have, when they measure physician and staff satisfaction, that improves as well. So happier doctors …"

And the doctors, unquestionably, are happier for the transition, Ziring says. That has also eased the transition to new work protocols, and other members of the care team, such as case managers and nurses, have direct contact with the patient in an advisory role.